Over the past few years, University Hospitals in Cleveland has achieved notable progress — delivering higher-quality care, creating better patient experiences and lowering costs. These achievements are worth celebrating, not just for the numbers themselves, but for what they represent: what’s possible when we align around a common purpose and act together.
We still face strong headwinds. But there is something more powerful than any challenge on the horizon: We have learned how to improve — and to do so faster, smarter and more sustainably than before. What some might once have dismissed as “soft skills” we now understand to be the essential skills for transforming care.
We have learned that true improvement happens only when every team member — regardless of role — understands that enhancing value is part of their responsibility, and when they feel empowered, capable and worthy of making a difference. When every voice is heard, every perspective respected and every role has a seat at the table, we create solutions that are stronger, more innovative, and more enduring.
One example is our work on preventing blood clots — a major cause of preventable harm that kills between 60,000-100,000 people annually in the U.S. Prevention seems simple: identify those at risk and give them medicine or use compression boots that repeatedly squeeze the legs to keep blood flowing. The challenge is that these boots work only when they’re used consistently, yet across the country, more than half the time they are not. Traditional boots must be plugged in, unplugged when a patient gets up and then plugged in again — something easy to forget, with no alarm to remind staff.
On Lerner Tower 9 at UH Cleveland Medical Center, the team refused to accept this as inevitable.
Assistant Nurse Manager Jessica found battery-powered boots that patients could wear while walking, eliminating the need to unplug and reconnect them. This innovation brought a new challenge: The boots needed daily battery checks and recharging. In many organizations, adding work becomes a burden no one wants to take on. But in a culture where safety is everyone’s job, solutions find owners. Michelle, the unit secretary, stepped forward, proudly declaring, “My job is to prevent blood clots. Every morning at 7 a.m., I check and charge the batteries.”
Compliance with compression boot use jumped from 31% to 68%, and now we are exploring spreading this innovation across the system.
We have also learned that excellence depends on robust systems of management and shared accountability. Too often, great ideas flourish in a pilot but fail to spread because they remain optional. At UH, we aim to make excellence an expectation, not an experiment. We know our management systems are working when we can show a run chart with a meaningful slope on something that truly matters — and measured consistently across the system.
Shared accountability means we look at results by hospital, clinic, unit and clinician — celebrating those who excel and providing targeted support to those who need it. This is not about blame; it’s about building a culture where success is scaled and challenges are addressed openly, with the shared aim of better outcomes for patients.
Medication safety is a powerful example of our transformation model in action, with barcoded medication administration (BCMA) serving as a great example. BCMA ensures that every administration the right medication is delivered to the right patient, at the right dose, through the right route and at the right time — the “five rights” of safe medication practice.
For years, we maintained a strong program with 95% adherence to best practices. Good, but with millions of medication doses administered each year, even small gains can prevent harm. By applying fractal management, System Pharmacy Medication Safety Manager Bridget and South Market CNO and System Director of Clinical Loss Control/Risk Julia made variation visible by sharing unit-level performance, celebrating high performers and supporting those needing improvement. Nurse managers also reviewed individual performance with nurses below target.
As a result, adherence climbed from 95% to 97% — and some departments now sustain as high as 99%. The impact is enormous: In June 2025 alone, we safely passed nearly 1 million medications across the system. By consistently achieving 97%-99% compliance, our teams not only reduce the risk of medication-related harm but also free up attention to address other areas of patient safety.
We have seen transformational results wherever this model has been applied — whether in increasing annual wellness visits, improving control of hypertension and diabetes, expanding cancer screenings, achieving shared savings, reducing complications, shortening length of stay, enhancing patient experience or improving observation rates.
Our work to improve annual wellness visits shows what’s possible at scale. These visits are one of the most effective ways for Medicare patients to improve their health, prevent disease and reduce costs. In 2019, UH was at 33%. PCI leaders set an ambitious goal of 60%.
Under the guidance of Drs. Kirpekar and Zeiger, with the help of the UH Population Health team and many partners, they built templates, provided training and coaching, and created peer learning communities. Data was shared transparently, with public praise for those meeting targets and one-on-one conversations with those falling short. Some required direct outreach from physician leaders, including Dr. Topalsky to ensure expectations were met.
The result: today, over 70% of our Medicare patients receive annual wellness visits — among the highest rates in the country — accompanied by substantial gains in colorectal and breast cancer screenings, and improved control of hypertension and diabetes.
This is our secret sauce. It’s why our transformation model — Living and Leading with Love — has been so impactful. It’s how we will face the challenges ahead. The winds may be strong, but our model is stronger.
To accelerate our progress, we must engage every caregiver, apply this approach more broadly and deeply, and commit to learning and improving faster than ever before. Our destination — Zero Harm — is bold. But together, we will get there.
The journey is ours to take. And together, we will make it.
Peter J. Pronovost, MD, PhD, FCCM, is the Chief Quality and Clinical Transformation Officer at University Hospitals in Cleveland and the Veale Distinguished Chair in Leadership and Clinical Transformation.
